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Shingles: Chickenpox in Children Reborn!

Can you remember having chickenpox as a child? The red itchy rash that gradually spread over your body and the little blisters that broke open, leaving sores which finally crusted over to become dry, brown scabs. Even if you can't remember it, you are almost certain to have had chickenpox; almost everyone gets it by adulthood. In the United States, chickenpox affects about 4 million (mainly children) a year. For most sufferers chickenpox is a relatively mild disease but it can cause more serious complications in adults and children with poor immune systems.

Once you've had one attack of chickenpox you can't get another, but the Varicella Zoster (VZ) virus that causes chickenpox has another surprise. It belongs to a group of viruses that stay in your body for life and lie dormant in one of the nerves that control skin sensation. Many years after the original chickenpox infection, the VZ virus "reactivates" in around 1 in 5 people. The newly reactivated virus is now called Herpes Zoster and affects the nerve to the skin causing a painful rash known as "Shingles".

You can't "catch" shingles, its not contagious! But each year more than 1 million Americans suffer from the disease when the original chickenpox virus reactivates as Herpes Zoster. When our immune system is healthy the virus is usually inactive. When age, stress or poor health compromise our immune system the virus can resurface as shingles. Shingles is most common in the elderly but can occur at any age with an illness such as cancer or with immunosuppressive medications such as corticosteroids.

The first sign of shingles is usually a tingling sensation in the skin, sometimes up to a week before the rash. The rash then follows the course of the affected sensory nerve as a band or patch of red bumps on only one side of the body. This one sided rash can occur on the torso, face, arms or legs and is an important diagnostic clue that shingles is the cause.

Typically the shingles rash is seen on one side of the chest or forehead and commonly lasts around a month. The hidden surprise with shingles is the severe pain that develops when the rash gets worse. The pain is persistent and can get so bad that it has been confused with a heart attack in some cases.

Although painful, shingles is usually not a serious condition but there can be serious complications. The most common complication of shingles is long term pain. In about 20% of cases the herpes zoster virus damages the nerve affected creating persistent pain known as post herpetic neuralgia (PHN). This pain can persist for months or years after the shingles rash heals and can be so severe that even the lightest touch on the skin is intolerable! Eye damage is the other significant complication of shingles. It is found in around 10% of cases involving the face.

Antiviral treatments such as acyclovir, famcyclovir and valacyclovir are helpful in reducing the severity of shingles, but only if used within the first 2 to 3 days of the rash developing. If PHN does occur, treatment is focused on managing the pain as there is no active cure. Urgent attention from an eye specialist is needed with any signs of shingles eye involvement as the damage caused can be sight threatening.

The one piece of good news on the horizon is that there is now a vaccine that can prevent chickenpox in 70 to 85% of those who receive it. Over time, as the safety and usage of this vaccine improves, the common childhood disease of chickenpox may eventually disappear and along with it the problem of shingles!